Anxiety in Children

School Refusal

What is School Refusal?

Going to school is not often on the top of many children’s list of enjoyable activities. The prospect of going to school after the holidays or a fun-filled weekend can often be met with reluctance and even some whining. Some children are more resistant, taking a long time to wake up and get ready for school. However, for a small population of children, going to school can pose such high levels of distress, that they refuse to attend school. Often these children can have overwhelming tantrums or meltdowns, refuse to leave the house, avoid getting into the car or school bus, or even lash out physically. It is not uncommon for the child to express that they are feeling physically ill, either at home to their parents prior to leaving for school, or during school hours through repeated visits to the school nurse or sick bay. The most common anxiety symptoms in children of physical sickness they may experience include stomach upsets, nausea, diarrhoea, headaches, and dizziness.

School refusal differs from truancy, in that parents are often aware that children are not attending school, and children are not absent from school in favour or more exciting activities. Often, children who engage in school refusal are experiencing high levels of distress and/or anxiety that requires support and treatment from a trained health professional. Research has linked school refusal to anxiety in the child, in particular separation anxiety and/or generalised anxiety disorder.

Left untreated, school refusal can have a significant detrimental impact on a young persons’ learning and development. Frequent absences can negatively impact a child’s social relationships and can also result in conflict and strain relationships with other members of the family due to disruption in routines. In the long-term, research has shown that school refusal can leave children vulnerable to a variety of mental health difficulties, social and emotional problems, and occupational dysfunction later in life.

How Common is School Refusal?

Research has shown that approximately 2 percent of all school-aged children experience school refusal. School refusal has also been shown to be more prevalent in the first year of school, at the end of primary school, and again at secondary school (i.e., transition times). It affects children from all walks of life but tends to be more common in youngest family members.

Symptom Checklist

In the absence of anti-social or other serious behavioural issues, does your child:

  • Throw tantrums or is defiant about going to school?
  • Get teary and repeatedly plead to stay home before going to school?
  • Experience extreme distress about being separated from you or at home before school?
  • Experience intense feelings of nervousness about going to school?
  • Complains about feeling physically ill before or during school frequently (e.g., stomach-aches, diarrhoea, headaches, dizziness)?
  • Refuse to leave the house or car to go to school?
  • Constantly visit the school nurse feeling ill and asking to be picked up?
  • Refuse to engage with peers or participate in social activities?
  • Experience difficulty attending school after holidays, weekends, or special event days?

What Treatments are Recommended for School Refusal?

The best treatment for school refusal anxiety symptoms in children is utilising a team approach, involving parents, the school, and a trained psychologist. Treatment involves a variety of psychological approaches, including Cognitive Behavioural Therapy (CBT), systematic desensitisation, and exposure therapy. The goal of CBT in school refusal is to help children correct maladaptive thoughts and beliefs contributing to their ongoing refusal to attend school, practicing relaxation techniques to manage their levels of anxiety, then developing and engaging a graded approach to returning to school.

How Parents Can Help?

Parents can help their children experiencing school refusal by:

  • Providing the child with routine and structure: anxious children benefit from a predictable home routine, and specific morning and evening routines. However, be mindful of over-scheduling, as this can increase stress for children.
  • Sleep: help your child establish healthy sleep habits and maintain a regular sleep cycle even on weekends and during school holidays.
  • Peer buddies: consider requesting a peer buddy for your child for periods of less structured activity in school (e.g., lunch/recess)
  • Listen and support your child rather than shaming them for not wanting to go to school
  • Talk to your child about their reasons for not wanting to go to school, and brainstorm some potential solutions for problems at school
  • Talk to your child about the positive aspects of school without ignoring their negative feelings
  • Avoid threatening your child for not going to school
  • Help their child seek help for their school refusal difficulties rather than assuming that they will “outgrow” it